|
GMRS MRH KEEL TIB BASEPLT SM 2
|
Facility
|
IP
|
$17,337.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,201.11 |
| Max. Negotiated Rate |
$16,643.57 |
| Rate for Payer: Aetna Commercial |
$13,349.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,522.90
|
| Rate for Payer: Cash Price |
$8,668.52
|
| Rate for Payer: Cigna Commercial |
$14,389.75
|
| Rate for Payer: First Health Commercial |
$16,470.20
|
| Rate for Payer: Humana Commercial |
$14,736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,216.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,794.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,201.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,256.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,002.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,869.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,083.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,962.56
|
| Rate for Payer: PHCS Commercial |
$16,643.57
|
| Rate for Payer: United Healthcare All Payer |
$15,256.60
|
|
|
GMRS MRH TIB INSERT 10MM M2/L2
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 10MM M2/L2
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 10MM S1/S2
|
Facility
|
OP
|
$7,588.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.63 |
| Max. Negotiated Rate |
$7,285.23 |
| Rate for Payer: Aetna Commercial |
$5,843.36
|
| Rate for Payer: Anthem Medicaid |
$2,609.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.25
|
| Rate for Payer: Cash Price |
$3,794.39
|
| Rate for Payer: Cigna Commercial |
$6,298.69
|
| Rate for Payer: First Health Commercial |
$7,209.34
|
| Rate for Payer: Humana Commercial |
$6,450.46
|
| Rate for Payer: Humana KY Medicaid |
$2,609.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,636.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,222.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,600.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,662.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,691.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.26
|
| Rate for Payer: PHCS Commercial |
$7,285.23
|
| Rate for Payer: United Healthcare All Payer |
$6,678.13
|
|
|
GMRS MRH TIB INSERT 10MM S1/S2
|
Facility
|
IP
|
$7,588.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.63 |
| Max. Negotiated Rate |
$7,285.23 |
| Rate for Payer: Aetna Commercial |
$5,843.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.25
|
| Rate for Payer: Cash Price |
$3,794.39
|
| Rate for Payer: Cigna Commercial |
$6,298.69
|
| Rate for Payer: First Health Commercial |
$7,209.34
|
| Rate for Payer: Humana Commercial |
$6,450.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,222.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,600.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,691.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.26
|
| Rate for Payer: PHCS Commercial |
$7,285.23
|
| Rate for Payer: United Healthcare All Payer |
$6,678.13
|
|
|
GMRS MRH TIB INSERT 13MM M2/L2
|
Facility
|
OP
|
$7,286.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,185.97 |
| Max. Negotiated Rate |
$6,995.10 |
| Rate for Payer: Aetna Commercial |
$5,610.65
|
| Rate for Payer: Anthem Medicaid |
$2,505.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,683.52
|
| Rate for Payer: Cash Price |
$3,643.28
|
| Rate for Payer: Cigna Commercial |
$6,047.84
|
| Rate for Payer: First Health Commercial |
$6,922.23
|
| Rate for Payer: Humana Commercial |
$6,193.58
|
| Rate for Payer: Humana KY Medicaid |
$2,505.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,531.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,974.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,377.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,185.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,556.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,412.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,464.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,829.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,339.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,027.73
|
| Rate for Payer: PHCS Commercial |
$6,995.10
|
| Rate for Payer: United Healthcare All Payer |
$6,412.17
|
|
|
GMRS MRH TIB INSERT 13MM M2/L2
|
Facility
|
IP
|
$7,286.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,185.97 |
| Max. Negotiated Rate |
$6,995.10 |
| Rate for Payer: Aetna Commercial |
$5,610.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,683.52
|
| Rate for Payer: Cash Price |
$3,643.28
|
| Rate for Payer: Cigna Commercial |
$6,047.84
|
| Rate for Payer: First Health Commercial |
$6,922.23
|
| Rate for Payer: Humana Commercial |
$6,193.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,974.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,377.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,185.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,412.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,464.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,829.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,339.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,027.73
|
| Rate for Payer: PHCS Commercial |
$6,995.10
|
| Rate for Payer: United Healthcare All Payer |
$6,412.17
|
|
|
GMRS MRH TIB INSERT 13MM S1/S2
|
Facility
|
IP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
GMRS MRH TIB INSERT 13MM S1/S2
|
Facility
|
OP
|
$7,415.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.51 |
| Max. Negotiated Rate |
$7,118.44 |
| Rate for Payer: Aetna Commercial |
$5,709.58
|
| Rate for Payer: Anthem Medicaid |
$2,550.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,783.73
|
| Rate for Payer: Cash Price |
$3,707.52
|
| Rate for Payer: Cigna Commercial |
$6,154.48
|
| Rate for Payer: First Health Commercial |
$7,044.29
|
| Rate for Payer: Humana Commercial |
$6,302.78
|
| Rate for Payer: Humana KY Medicaid |
$2,550.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,575.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,080.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,472.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,224.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,601.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,525.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,561.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,932.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,451.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,116.38
|
| Rate for Payer: PHCS Commercial |
$7,118.44
|
| Rate for Payer: United Healthcare All Payer |
$6,525.24
|
|
|
GMRS MRH TIB INSERT 16MM M2/L2
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 16MM M2/L2
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 16MM S1/S2
|
Facility
|
OP
|
$7,489.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.74 |
| Max. Negotiated Rate |
$7,189.57 |
| Rate for Payer: Aetna Commercial |
$5,766.64
|
| Rate for Payer: Anthem Medicaid |
$2,575.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,841.53
|
| Rate for Payer: Cash Price |
$3,744.57
|
| Rate for Payer: Cigna Commercial |
$6,215.99
|
| Rate for Payer: First Health Commercial |
$7,114.68
|
| Rate for Payer: Humana Commercial |
$6,365.77
|
| Rate for Payer: Humana KY Medicaid |
$2,575.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,601.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,141.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,526.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,627.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,590.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,616.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,991.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,515.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,167.51
|
| Rate for Payer: PHCS Commercial |
$7,189.57
|
| Rate for Payer: United Healthcare All Payer |
$6,590.44
|
|
|
GMRS MRH TIB INSERT 16MM S1/S2
|
Facility
|
IP
|
$7,489.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.74 |
| Max. Negotiated Rate |
$7,189.57 |
| Rate for Payer: Aetna Commercial |
$5,766.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,841.53
|
| Rate for Payer: Cash Price |
$3,744.57
|
| Rate for Payer: Cigna Commercial |
$6,215.99
|
| Rate for Payer: First Health Commercial |
$7,114.68
|
| Rate for Payer: Humana Commercial |
$6,365.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,141.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,526.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,590.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,616.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,991.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,515.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,167.51
|
| Rate for Payer: PHCS Commercial |
$7,189.57
|
| Rate for Payer: United Healthcare All Payer |
$6,590.44
|
|
|
GMRS MRH TIB INSERT 20MM M2/L2
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 20MM M2/L2
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 20MM S1/S2
|
Facility
|
OP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem Medicaid |
$2,292.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Humana KY Medicaid |
$2,292.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
GMRS MRH TIB INSERT 20MM S1/S2
|
Facility
|
IP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
GMRS MRH TIB INSERT 22MM S1/S2
|
Facility
|
OP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem Medicaid |
$2,292.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Humana KY Medicaid |
$2,292.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
GMRS MRH TIB INSERT 22MM S1/S2
|
Facility
|
IP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
GMRS MRH TIB INSERT 24MM M2/L2
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 24MM M2/L2
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
GMRS MRH TIB INSERT 24MM S1/S2
|
Facility
|
OP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem Medicaid |
$2,292.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Humana KY Medicaid |
$2,292.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
GMRS MRH TIB INSERT 24MM S1/S2
|
Facility
|
IP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
GMRS PRESS FIT EXT 10MM*155MM
|
Facility
|
IP
|
$5,732.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.83 |
| Max. Negotiated Rate |
$5,503.44 |
| Rate for Payer: Aetna Commercial |
$4,414.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,471.55
|
| Rate for Payer: Cash Price |
$2,866.38
|
| Rate for Payer: Cigna Commercial |
$4,758.18
|
| Rate for Payer: First Health Commercial |
$5,446.11
|
| Rate for Payer: Humana Commercial |
$4,872.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,700.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,230.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,044.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,299.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,586.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,987.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,955.60
|
| Rate for Payer: PHCS Commercial |
$5,503.44
|
| Rate for Payer: United Healthcare All Payer |
$5,044.82
|
|
|
GMRS PRESS FIT EXT 10MM*155MM
|
Facility
|
OP
|
$5,732.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.83 |
| Max. Negotiated Rate |
$5,503.44 |
| Rate for Payer: Aetna Commercial |
$4,414.22
|
| Rate for Payer: Anthem Medicaid |
$1,971.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,471.55
|
| Rate for Payer: Cash Price |
$2,866.38
|
| Rate for Payer: Cigna Commercial |
$4,758.18
|
| Rate for Payer: First Health Commercial |
$5,446.11
|
| Rate for Payer: Humana Commercial |
$4,872.84
|
| Rate for Payer: Humana KY Medicaid |
$1,971.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,991.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,700.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,230.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,011.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,044.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,299.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,586.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,987.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,955.60
|
| Rate for Payer: PHCS Commercial |
$5,503.44
|
| Rate for Payer: United Healthcare All Payer |
$5,044.82
|
|
